Weekends at Bellevue (17 page)

The weekend before I received the letter, I had kicked out a lying
patient who was from Philadelphia, and he swore he would “come back to hunt me down.” The postmark is from Philadelphia. Maybe the letter’s from him.

I decide to compile a list of likely patients by combing through the discharge records from the past few weekends. I’ll give the list to hospital security and to NYPD. A detective assigned to the case comes by my apartment to speak to me and leaves his card under my door, since I’m not home. When I ask the doorman about it, he has no recollection of letting the man in.

I explain why he should be extra-cautious about anyone who says he is there to see me.

I
t begins as a day unlike any other: nine o’clock, Wednesday morning, May 20, 1998, and I’m shot full of drugs. Lying on a stretcher, I am mildly amused at the television show I’m watching: It is my colon, bloodred and slick with mucus.

“Fabulous,” gushes my doctor. I nod my head in agreement. It is my first colonoscopy, surprisingly painless. Maybe it’s just the Demerol and Valium talking, but I am pleasantly conversant throughout the procedure. Afterwards, it takes several hours to come down from my high. As I walk back to my apartment, I delight at my surroundings. It is a beautiful spring day, unseasonably warm. The trees are flowering on Park Avenue, and there are tulips and daffodils in the gardens in front of the high rises.

I am working tonight, subbing in for my best pal Lucy, and I decide—as I glide home, stoned—to walk to the hospital, seventy blocks south. After working at Bellevue for two years, it will be my first time walking there. (Over my nine years there, I will never walk to work again.)

I arrive for rounds a few minutes late, glistening with sweat. Lucy pulls me aside after sign-out and tells me in the hallway that it’s official: She’s been made Director of CPEP. Dr. Lear is leaving, and he has picked her to be his replacement. I am thrilled for her. For us.

“Are you sure I can’t convince you to work weekdays with me?” Lucy asks. “You could be my assistant director. We’d be a hell of a team.”

“I know we would, and I would so love to be your right-hand man,
dudette. But I’ve gotten very used to my weeks off. I love flying solo on the weekends; you know that. I just can’t give up this schedule. Even for you.”

“I know you can’t. I probably wouldn’t do it if I were you,” she smiles. She then asks me what I think about Daniel. “You know him from Sinai, right? I’m thinking about pulling him from 18 North to work at CPEP. You think it’s a good idea? Daniel down here to be the assistant director?”

“Well, he’d certainly be an improvement over the one we have now. He’ll be fine … sure,” I say, trying to convince myself as I sell Lucy. It’s hard to imagine working side by side with Daniel again after Sinai. I’m not sure how I feel about it exactly, but I don’t share my indecision with Lucy. I don’t want to pull the focus away from her promotion. She’s been told to keep it quiet for a while, mostly out of respect for the current A.D. who thought the job would be his, so I spend the first part of my shift feeling like the cat who ate the canary. I know staff morale will skyrocket once everyone hears the news—everyone loves the ballsy and charismatic Lucy.

The CPEP gets busier as the afternoon wears on. I usually start my shift a bit later when I work the weekends: Working for Lucy on a Wednesday means coming in at four instead of seven. I’m happy to do her this favor, but it occurs to me soon after she leaves that it’s going to be a long night.

The skies darken early; a hard rain is imminent. The EMS cases start pouring in. I hear Rita, behind her desk, on the phone talking to her son, “No, seriously, it’s hailing now?!”

The last time I was in a May hailstorm was in a rental car in the middle of wide-open “Color Country” in Utah. The hail pounded on the roof, and Jeremy and I were absolutely panicked that a tornado would come barreling through the prairie and take the car up into its funnel. Rita says “hail,” I think
panic
.

The nondetainable area is filling up, and the night has a weird vibe to it. It feels like being on a ship that is taking in water from all sides. Not only is one ambulance case after another coming in, but I am getting a lot of calls from other hospitals. Everyone else is full, the rest of the city is jam-packed with psych cases, but for some reason Bellevue has scads of empty beds—the only beds in the city. So I am accepting transfers from other hospitals, which always pisses off the nurses, adding to everyone’s workload. I am obligated to take the psychotic prisoner referrals, but I also accept a couple of homeless guys with no
insurance, knowing full well no other hospital will accept these patients since they can’t pay for services.

And now, to make matters worse, the ER is dumping wrist slits on me: two in a row, back-to-back transfers, both drunk at the time they cut their wrists, and both sober now. One had lethal intent—he really was hoping the cuts would be deep enough for him to bleed to death, so he gets admitted upstairs to an inpatient psych bed. The other is a drunk “hitting bottom,” as they say, with superficial cuts requiring no sutures. We confirm with him that this is a “cry for help,” and he is admitted to a detox bed.

There are so many patients on triage that not only the moonlighters—three hired hands to help out with the evening overflow—but also the medical students are having to see cases individually. “Divide and conquer!” I encourage them, even though the medical students typically work in pairs or shadow the moonlighters.

It’s raining like crazy out there; the lightning strobes against the EOU windows. The resident on-call presents a new case to me, and as we discuss it, I sense that her new patient is malingering. He gave conflicting stories to the triage nurse and the resident, and he’s keeping a very low profile in the ER, slouching down underneath a yellow hooded sweatshirt like he’s hiding out. I ask the resident to reinterview the patient, and now he’s saying anything he can think of to be admitted, upping the ante with each interview, but he’s having trouble keeping his story straight. I go out to speak with him after I notice that he’s given the clerk a home address that’s very near my own, a nice block on the Upper East side. I’m curious about his living in my neighborhood, and when I ask him where the block is, he tells me it’s between Second and Third, though the address he gave the clerk is between Park and Madison. I question him about this, and he then “admits” it is his wife’s address and that they are separated.

“And you’re confused about what block she lives on since the separation?” I jab. He looks at me quizzically, angrily, and I get up to leave, quitting while I’m ahead.

When the resident and I rehash the case in the nurses’ station, we decide that the patient is “F.O.S.” (full of shit) and needs to leave. He isn’t mentally ill; he’s clearly faking it in order to gain admission to the hospital. We’re pretty sure he’s a sociopath; we sometimes call them sharks. Guys like this enjoy their time in the hospital, easier than the streets or
shelters, and certainly more cushy than jail time, which is where most sharks end up. It’s my job to make sure that sociopaths don’t get into Bellevue. Not only do they take up a bed that could be better utilized, but they also make the hospital a more dangerous place. Sharks have a tendency toward violence and they prey on the weak—in this case, the vulnerable psychiatric patients.

As always, I am eager to kick out a malingerer, excising him like a malignant tumor. As I go out to talk to him, a moonlighting doctor suggests that I take someone with me, that maybe this patient is dangerous. Walking out of the nurses’ station, I say brazenly, “I’ve been here two years and haven’t gotten tagged yet. Maybe I’m due.”

I walk over to the man in the yellow sweatshirt, and he responds to my inquiries very quietly. So quietly, in fact, that I need to lean in toward him so that I can hear his responses.

“Mr. Brown, we’re having a little problem regarding your patient information. It’s just not adding up,” I begin.

“So?”

“So, some of the doctors here think that you may be feigning your illness.”

“Feigning?” he asks. “Faking,” I explain.

And then it comes. A huge fist flies into my face, and as I hear the smack, I see a flash of bright white light. I stagger backwards from the force of the blow. Eleanor, the largest female psych tech we have, is on him in a heartbeat, tackling him to the ground, while I take another step back, and then another, stunned.

“I got him, Doc,” Eleanor calls to me proudly as I scurry back to the nurses’ station.

“I want to press charges, Eleanor!” I shout back to her. The hospital police have already come to help out, reminding me that this is an option, and I want them to take him away. Rocky is there, front and center, acting professionally, not making a big deal of the irony that I can’t help but notice. The guy I almost got fired is now the cop who’ll arrest my shark.

I sit down for a minute, shaky, talking nervously, trying to make light of the whole scene, and the next thing I know one of the medical ER doctors has run over to check me out. It’s a good friend of Lucy’s, another lesbian with a down-home drawl I feel a special connection to,
and I’m glad she’s on duty tonight. She helps me feel I’m in capable, caring hands as she masterfully palpates the cheekbones under my eyes to feel for a fracture, and recommends I get a skull X-ray just to be sure. I sit in the radiology suite like a patient, with a rubber glove filled with ice pressed against the bruise beginning to form on my cheek, and I try not to cry.

When the buzz has died down in CPEP, and my facial series has been cleared by the radiologist, I lie low in the nurses’ station, not willing to go home and abandon my shift, but also not fully willing to reengage with the patients or the paperwork.

Later Rocky comes by to tell me that Mr. Brown has been arrested and taken to the thirteenth precinct. He makes a point of relating to me the opening sentence on the arrest paperwork. Rocky has quoted him word for word, “I wanted to hit the doctor. I hope I got her good.”

I imagine it will be hard to plead innocent with a statement like that. When I speak to the assistant district attorney later in the week, I learn that the man has over twenty “priors.” They don’t even need me to come down to testify. I fax over some short forms and the deed is done. He will spend the next four months at Rikers.

Jeremy figures that this guy needed to be off the streets so badly, if he couldn’t be admitted to the hospital, he’d do his time in jail instead. Otherwise, why be so bold about punching me, setting me up with his quiet voice, confessing to it immediately? Or is it just that he is a bad guy? Maybe he’s simply a violent man who doesn’t care what the consequences are, he just wanted to “get me good.”

What I can’t stop wondering is, Did he get me good enough? Might he come looking for me when he gets out of Rikers to get me again?

O
n Monday, I play a little game with Mary to see if she can see the bruise on my face. “Notice anything different about me?”

“Did you get your hair cut?” she asks, confused.

“Not exactly. Look at my cheek.”

“Ooh, how’d you get that?” she asks, getting up off her chair to examine my bruise.

“Funny story,” I begin, but of course, just hearing myself try to make a joke of it, I begin to cry. I cover my face with my hands to hide the ugly grimaces that typically accompany my tears.

“What happened?” she asks, so caring and concerned, so loving and open and able. She is standing right in front of me, not quite sitting back down in her chair, although I imagine she wishes she’d never gotten up.

Part of me wants her to hold me, and to comfort me. The more grown-up part, the psychiatrist in me, knows that this would be inappropriate, and that I need to soldier on, to talk about it so we can do our work.

“I got punched in the face by a patient.”

She sits down in her chair and waits. She’s not going to say a word until I completely unload. I could never be this patient with a patient. She has so much to teach me about being a good therapist. I need to remember to wait while I listen.

“I called him on his shit and he punched me. He whispered real quiet
so I had to lean in to hear him and then he popped me, hard, right in my face. Have you ever been punched?” I ask, rhetorically. No self-respecting shrink would answer that, I imagine. “No, I haven’t,” she answers calmly.

“I hadn’t either. It’s really interesting, the physics of it. It’s like a cartoon caption. You know, the ones that say BLAM! There’s a big white jagged disc that accompanies the fist, that spins off of the impact. The energy of a fist and a face, when they collide, it creates a separate thing. It’s got heat. It vibrates. It actually pushed me backwards.”

“I think maybe you need to get beyond the interesting physics of the collision here, Julie. Can you tell me why this happened?” Mary makes it clear that I’m wasting valuable time.

“He was a malingerer. He was lying about his address and I caught him on it. I confronted him, told him I thought he was lying, and he punched me.”

“Is there more?” she asks simply.

“I’m sure he thought I was being a smug asshole.”

“And you think?”

“That he was probably right. I couldn’t wait to call him on it. Jeremy says it was emasculating. And that is obviously not therapeutic. He says I’m not helping these patients. Whatever is going on with them, whether they’re lying or telling the truth, the bottom line is they’re coming to me as a physician for assistance and then leaving empty-handed. I’m leaving them hanging. Dissatisfied. Only worse than that. They’re insulted.”

“It’s probably humiliating enough for them to be in the position of approaching the Bellevue psych ER asking for assistance. You don’t need to add to their shame.”

“So why did I do that? I think I get caught up in the cat and mouse of it. I get excited that I’ve figured out their game. I’m on to them and I want them to know they’re not getting anything past me. But that’s not what it should be about, right?”